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Do I need to start Vetmedin?

karen100

karen100

Active member
Last August my 10 year old, Buddy, was diagnosed with a stage 2-3 heart murmur. The x-ray and probnp test all came back fine-no enlarged heart or signs of CHF. Because he was symptomatic (exercise intolerance and general unwellness) he was put on furosemide and benazapril, which worked miracles. He was back to his old self until this past April, when all the old symptoms started up again.

I have a vet appt tomorrow, but wanted to get your opinion on the next step. I can’t afford a cardiologist or a cardiogram. At this stage, should the meds be increased or should vetmedin be added? Buddy is currently on 20 mg of furosemide and 5 mg of benazapril.

thanks
 
Hiya,
Sorry about Buddy. My Leo was started on Vetmedin for his heart 18 months ago and has done great on it.
I know some say its a last resort drug and shouldn't be started until the dog is in end stages of heart failure but from my experience its been hugely successful with giving Leo much, much more "quality" time.

He had a Heart scan last month and his heart had only deteriorated a little since the last scan 12 months ago.
I posted this morning about his energy levels and his playfulness today...its great :)

My only advice is go with what your vet suggests (providing you trust him) I trust my vet so go with their advice.
As I said I know others are not fans of Vetmedin but I can only give you my experience.
I hope Buddy gets the treatments he needs and improves.

Good luck
Mel
 
thanks Mel. I’m so glad little Leo is doing well. Can you tell me what meds besides the vetmedin he’s been on, and on what dose, or is he only on Vetmedin?
 
Hiya,
Leo is also on 20mg Frusemide twice a day and 2.5mg Cardalis once a day. His Vetmedin dose is 1.25mg twice a day.
He was on 10mg Frusemide but I noticed he was beginning to cough a little more. The vet suggested I increase the Frusemdie to 20mg which I did and he improved.

My vet did say that sometimes the dosage of the meds needs to be jiggled about at times until you find what works.
When Leo was first diagnosed I was obviously very upset and worried what the future held. My vet reassured me that she had seen some Cavaliers do really well if they respond to the meds.

I hope Buddy responds as well as Leo has
 
thanks Mel, that’s reassuring. Right now Buddy is on 20 mg of furosemide a day, half in the morning and half at supper, and 5 mg of benazapril (fortekor), once a day in the morning. I’ve not heard of Cardalis. Is that an ACE inhibitor like fortekor?
 
Buddy had his vet appt and they did an xray. Physical exam: murmur on the left side, increased to a 3/4. A “whooshing” or muffled heart sound on the right side. The vet wondered if there was fluid there which caused it. She thought his lung sounds were normal, no crackling etc.

Xray: showed progression of disease compared to last year. Ventrical score was “high normal”, but the heart shape was “D” shaped, or rounder. (As an aside, I had read a cardiologist describe the heart in the early stages of failure being “globular”, so I wonder if that describes Buddy’s heart). Here’s where it gets confusing: the vet saw fluid in the airways, and possibly two small white spots that could be tumours. She wasn’t sure. She also speculated that Buddy’s heart problem might be secondary to an airway disease. I have a hard time thinking this is the problem, since I would expect there to be coughing. At this point, Buddy coughs occasionally, but not what I would expect of an animal with COPD.

So basically Buddy is an anomaly to the vet. A cardiologist is several hours away but unfortunately not affordable. (This visit cost me $560 which I can ill-afford.) Since Buddy is exercise intolerant, has a rapid at-rest respiratory rate and other signs of early CHF, we decided to do a two-week trial of Vetmedin and see if that relieves Buddy’s symptoms.

I really hope he doesn’t have cancer!
 
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Hi Karen

Im so sorry to read you've had this news about Buddy. Unfortunately you are so right, sometimes its not possible financially or travel wise to see a cardiologist.
I really hope the Vetmedin improves his symptoms. I also really hope he doesn't have cancer too......these little dogs can be such a worry cant they.
Someone else on the board maybe able to offer more info on what you've been told...it can be so confusing.

Ive got everything crossed things will work out for you and Buddy. Keep us uptodate and give him as many cuddles as you can....

Take care
Mel x
 
Opinions seem to be divided about when to start vetmedin. Some cardiologists feel that it stimulates the heart too much if started before the dog goes into CHF, others that if started earlier it can delay CHF by keeping the heart working well. It sounds as if Buddy is showing signs of CHF and therefore vetmedin will be effective. As Karen says, it has helped Leo enormously, and it helped to keep my Aled going for 7 months, in spite of having both valves out of action. Hope the spots on the x-ray turn out to be nothing serious:xfngr:

Kate and Ruby (my new rescue)
 
thanks Kate. That’s what I thought too, although I’m scared out of my mind using the vetmedin. I gave him his first dose last night after the vet appt and the second dose this morning. He’s kind of mopey and his tail is down. I really hope this works and doesn’t cause problems. Ditto on the xray spots too.
 
There are telemedicine websites which provide for general practice vets to consult with veterinary cardiologists by telephone and the Internet. There are links to three of them here: http://www.cavalierhealth.org/Cardiologists.htm#Worldwide

I would not start Vetmedin before heart failure (and even then, not before a specialist performs an ultrasound to determine if the dog's heart's contractility is low enough to need the drug), for a few reasons. First, the manufacturer warns against using it before heart failure and before the heart's contractility is too low to adequately perform on its own. Second, in the USA, the Food & Drug Administration prohibits it. Third, I know of several cavaliers which have died from the effects of Vetmedin when prescribed too early. Fourth, the ACVIM Consensus Statement does not recommend using it prior to congestive heart failure and low contractility.
 
I also wished the vet consulted with a cardiologist, either online or by phone. Don’t know why they don’t. I would even pay for the consult, assuming it wouldn’t be prohibitive.

Edited to Add: This article supports your concerns, Rod. I was somewhat relieved when I read the following: “Pimobendan should be used only in dogs that are symptomatic for heart failure (modified NYHA class II-Iv) since Buddy would certainly fit into the II/III category.

However, the author also suggests that Vetmedin would be more appropriate for dogs with DCM rather Mitral Valve Disease, which would therefore exclude most dogs (like caviess) who are on it the drug and clearly benefiting from it.
 
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Karen, where do you live? If you are paying $560 for a visit to your vet you can probably afford a cardiologist. I live in the greater NYC area and that's about what a visit with a sonogram cost me, and we are in one of the most expensive markets in the US. I do understand the distance being an issue however.

As an alternative, are there any heart clinics near you that you could dog to? I know CavalierHealth.org lists some but given you are in Canada, I'm not sure what your options are. But you might want to call the Cardiologist and discuss what the pricing would look like for your next visit. If not a clinic, perhaps there is a veterinary school nearby
that has reduced pricing?
 
Thanks Lani. I’m in southern ontario. The $560 included other non-heart items like his heart worm test/meds, nail trim, treats, etc. but yes, the lion share of the cost was the xrays and vetmedin.

The veterinary college in Guelph is about 3 hours away. I wish now I just asked to be referred to a cardiologist rather than waste the 500 bucks on a vet who couldn’t really tell me anything.
 
thanks Kate--Montreal is too far, but on the list you provided I saw that the University of Guelph, which is closer, also offers consultation to vets. I have a call into the vets today to ask about getting that done.
 
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